Impulse Noise Exposure Research Articles

Temporal Changes in Functional and Structural Neuronal Activities in Auditory System in Non-Severe Blast-Induced Tinnitus.

Background and Objectives: Epidemiological data indicate that blast exposure is the most common morbidity responsible for mild TBI among Service Members (SMs) during recent military operations. Blast-induced tinnitus is a comorbidity frequently reported by veterans, and despite its wide prevalence, it is also one of the least understood. Tinnitus arising from blast exposure is usually associated with direct structural damage that results in a conductive and sensorineural impairment in the auditory system. Tinnitus is also believed to be initiated by abnormal neuronal activities and temporal changes in neuroplasticity. Clinically, it is observed that tinnitus is frequently accompanied by sleep disruption as well as increased anxiety. In this study, we elucidated some of the mechanistic aspects of sensorineural injury caused by exposure to both shock waves and impulsive noise. The isolated conductive auditory damage hypothesis was minimized by employing an animal model wherein both ears were protected. Materials and Methods: After the exposure, the animals' hearing circuitry status was evaluated via acoustic startle response (ASR) to distinguish between hearing loss and tinnitus. We also compared the blast-induced tinnitus against the well-established sodium salicylate-induced tinnitus model as the positive control. The state of the sensorineural auditory system was evaluated by auditory brainstem response (ABR), and this test helped examine the neuronal circuits between the cochlea and inferior colliculus. We then further evaluated the role of the excitatory and inhibitory neurotransmitter receptors and neuronal synapses in the auditory cortex (AC) injury after blast exposure. Results: We observed sustained elevated ABR thresholds in animals exposed to blast shock waves, while only transient ABR threshold shifts were observed in the impulsive noise group solely at the acute time point. These changes were in concert with the increased expression of ribbon synapses, which is suggestive of neuroinflammation and cellular energy metabolic disorder. It was also found that the onset of tinnitus was accompanied by anxiety, depression-like symptoms, and altered sleep patterns. By comparing the effects of shock wave exposure and impulsive noise exposure, we unveiled that the shock wave exerted more significant effects on tinnitus induction and sensorineural impairments when compared to impulsive noise. Conclusions: In this study, we systematically studied the auditory system structural and functional changes after blast injury, providing more significant insights into the pathophysiology of blast-induced tinnitus.

Managing occupational impulsive noise from explosive depth hardening operations

The assessment and identification of measures to eliminate or reduce risks from occupational exposure to impulsive noise for the protection of hearing of employees in industry is an important yet comparatively neglected technical area. The aim of this work is to examine the current best practice to assess auditory hazards associated with impulsive blast noise generated by an infrastructure test process at a UK-based test site. A summary of the literature is presented on the measurement methodologies, hearing conservation and relevant guidance for the selection of hearing protection within the context of near-field impulsive noise. The current UK best practice recommends the adapted HML method from Defence Standard 0027:2015, using a C-peak measurement of exposure to compare with the national regulations. On-site measurements of personnel exposure were made at the DNV Spadeadam Testing and Research Site (STaR), of an industrial process known as Explosive Depth Hardening. Analyses of the trials data show that the C-peak personnel exposures resulted in acceptable levels below the 140 dBCpk limit within the national regulations when using the prescribed hearing protection, according to the adapted HML method. Waveforms recorded of repeated charge sizes were uncorrelated and additional signal artefacts were present. It is concluded that the adapted HML assessment is unclear on how excessive low-frequency content and multiple pressure peaks are accounted for in the assessment of hearing protector performance. The implication of this work is that further research is required to improve current best practice to quantify the uncertainties introduced by the additional characteristics found within real impulsive noise exposures.

Dolphins reduce hearing sensitivity in anticipation of repetitive impulsive noise exposures.

The auditory steady-state response (ASSR) was continuously measured in two bottlenose dolphins during impulse noise exposures to determine whether observed head movements coincided with actual changes to auditory system sensitivity. Impulses were generated by a seismic air gun at a fixed inter-pulse interval of 10 s. ASSR amplitudes were extracted from the instantaneous electroencephalogram using coherent averaging within a sliding analysis window. A decline in ASSR amplitude was seen during the time interval between air gun impulses, followed by an elevation in ASSR amplitude immediately after each impulse. Similar patterns were not observed during control trials where air gun impulses were not generated. The results suggest that the dolphins learned the timing of the impulse noise sequences and lowered their hearing sensitivity before each impulse, presumably to lessen the auditory effects of the noise. The specific mechanisms responsible for the observed effects are at present unknown.

Adaptation of the hearing analyzer under vibration noise exposure in volunteers: Ways of prevention

BACKGROUND: The negative effect of impulse noise and vibration when using small arms on the auditory analyzer in athletes is less investigated and justifies the need for an extended study of volunteers with normal hearing. The study of the initial characteristics of the impulse noise and vibration effects of sports weapons on the auditory analyzer will make it possible to determine the early risk factors for the occurrence of high-frequency hearing loss in shooters by the number of shots from sports weapons and the recovery time of auditory function. AIMS: To conduct a comparative analysis of the effect of impulse noise and vibration exposure depending on the technical characteristics of small arms on volunteers with normal hearing and, based on the results obtained, unify the methods of forecasting and prevention. MATERIALS AND METHODS: At the Department of Otorhinolaryngology of the South Ural State Medical University of the Ministry of Health of Russia, 30 fifth-year students were examined following continuous recruitment of volunteers between September 2022 and November 2022. All interviewed participants gave voluntary written consent to participate in the survey and to the test level of impulse noise. Based on the current regulatory documents, all volunteers were surveyed and underwent audiological and vestibulometric studies, the technical characteristics of noise and vibration exposure as a risk factor for the early development of presbycusis were determined, and ways of preventing hearing loss through lifestyle were proposed. RESULTS: The comparative analysis of the influence of impulse noise and vibration effects showed a dependence on the weight of the small arms cartridge, number of shots, and adaptation time of the auditory analyzer in volunteers with normal hearing considering the changes in the high-frequency spectrum of increasing audiometry thresholds from the average value of indicators. CONCLUSIONS: The use of active explanatory propaganda among young people on a careful attitude to the physiological state of the cochleovestibular apparatus avoids the risk of early presbycusis development.

Effect of hearing protection attenuation on impulse insertion loss and kurtosis

Kurtosis (the fourth standardized moment of the sound pressure) has been used to assess the additional risk of hearing loss for complex or impulsive noise exposures. Murphy et al. [2012] reported the impulse peak insertion loss of five hearing protection devices (HPDs) for firearm impulse noise. Fackler et al. [2017] reported a spectral insertion loss for several HPDs assessed with firearm and shock tube impulse noise sources. Murphy [2019] previously reported the effect of five hearing protection devices on the kurtosis and insertion loss assessed with jackhammer noise. Unprotected Jackhammer noise exhibited kurtosis values between about 15 to 17, whereas protected exposures exhibited kurtosis between about 3 to 12. Anderson and Argo [2022] reported that insertion loss was unaffected by kurtosis level for seventeen HPDs measured on an acoustic test fixture under headphones. This paper will apply the complex transfer functions from Murphy et al. [2012] to the jackhammer noises measured by Murphy [2019]. The levels of the unoccluded noises transformed to the ear canal of the fixture will be compared to occluded jackhammer noises levels measured in the fixture.

Assessment of hearing loss risk due to impact noise in industrial environments

Impact noises are often found in industrial environments and they are predominant in mining, construction, factories, workshops, and shipyards. It is well-known that impact noises are more likely to cause noise-induced hearing loss than continuous noise of equal energy. Impulse noises are characterized by their high intensity over a short period of time and many countries have defined impulse noise exposure limits and criteria in occupational settings. They are based on the sound level measurements made using standard sound pressure level meters and dosemeters. However, because of their metrological limitations, it is not appropriate to use these instruments when dealing with such high peak levels and short duration times. Extensive research on hearing damage produced by impulse noise generated by firearms has been presented, mainly on police and military personnel. These studies have led to damage risk criteria contained in various versions of the standard MIL-STD-1474. Although industrial noises can reach similar peak sound pressure levels, not many results have been published on the subject. In this work, several common sources of industrial impact noise were measured in-situ, at the worker locations, using a specialized system equipped with high-dynamic-range microphones and a very high data acquisition rate. The signals were post-processed to obtain the main metrics defined for impulse noise exposure assessment. Then, occupational hearing loss risk was estimated using different criteria. It is shown that many common industrial processes reported a very high risk of impulsive noise to human hearing.

Occluded insertion loss from intracochlear pressure measurements during acoustic shock wave exposure

IntroductionInjuries to the peripheral auditory system are among the most common results of high intensity impulsive noise exposure. Hearing protection can mitigate this injury, but careful assessment of the insertion loss they provide is necessary. Insertion loss is typically measured using microphone-based acoustic manikins to measure the decrease in sound pressure level transmitted into the ear canal, which precisely measure the change in air conducted sound, but neglect alternate pathways to the inner ear such as bone conduction. In a previous study we reported intracochlear pressures in cadaveric human specimens to acoustic shock waves, which revealed a substantial bone conducted component (Greene, et al., 2018). Here we evaluate insertion loss to several hearing protection devices (HPDs) in those same specimens using intracochlear pressure measurements. MethodsHuman cadaver heads were exposed to impulsive acoustic pressure waves with peak overpressures of 7 and 28 kPa (171 & 183 dB SPL). Ear canal (EAC), middle ear, and intracochlear sound pressure levels were measured bilaterally with fiber-optic pressure sensors. Surface-mounted sensors measured SPL and skull strain near the opening of each EAC and at the forehead. Responses were measured with specimen ears unoccluded, as reported previously, as well as fitted with four types of HPDs. Impulse peak insertion loss (IPIL) and impulse spectrum insertion loss (ISIL) were calculated for each HPD. ResultsFor all HPDs, IPIL generally increases with exposure level, though ISIL tended to be more consistent, and the spectral characteristics across frequency appear to be highly dependent on exposure level. ISIL measured in the ear canal tended to overestimate insertion loss measured in the cochlea, particularly at frequencies > 1 kHz; however, low signal-to-noise in intracochlear pressures limited comparisons. As a proof of concept, 36 low-level unoccluded exposures, were averaged together, and the resulting signal-to-noise ratio was improved by up to 15 dB. ConclusionsInsertion loss measured in the cochlea was lower than in the ear canal, suggesting substantial contributions from transmission pathways in parallel with air conduction (e.g., bone conduction) were present, which will require novel strategies to mitigate. However, high variance was observed, and noise reduction strategies should be utilized in future studies to facilitate more precise insertion loss estimates.

Supra-threshold deficits in normal hearing military recruits exposed to impulse noise.

The aim of this study was to determine the effect of impulse noise exposure on various proxy measures of cochlear synaptopathy in young military recruits. A total of 27 military recruits with exposure to firearm and artillery noise and 13 non exposed participants were recruited. All presented with normal hearing thresholds and the presence of distortion product otoacoustic emissions (DPOAEs). The Noise Exposure Structured Interview (NESI) was used to quantify noise exposure. Speech perception in noise (SPiN), equivalent rectangular bandwidth (ERB) of auditory filters, auditory brainstem response wave I amplitude, wave I amplitude growth function, wave I/V amplitude ratio, wave V latency, wave V latency shift with ipsilateral noise, and the summating potential/action potential ratio of the electrocochleography were measured. In military participants, SPiN was worse, ERB at 4 kHz was larger, wave I amplitude at 75 dBnHL was reduced, and wave V latency was delayed. However, no significant correlations were observed between NESI and auditory measures, once multiplicity of tests was controlled for. These results suggest that military recruits may exhibit supra-threshold deficits, despite presenting with normal hearing thresholds and presence of DPOAEs. Future studies should include a measure of auditory filters in their test battery.

When is a firearm suppressor like a hearing protector?

High-level impulse noise exposure from small caliber firearms presents a significant risk of noise induced hearing loss (NIHL) for an unprotected ear. The most common method to reduce the level of noise is to provide hearing protection to both the shooter(s) and potential observers such as firing range instructors or bystanders. Not all hunters and shooters consistently use correctly fit hearing protection. Firearm suppressors provide an engineering noise control that can mitigate a significant portion of the NIHL risk. In this paper, potential analyses for the noise reduction of a firearm suppressor will be presented. The impulse insertion loss as a function of the measurement analysis time window for A-weighted, C-weighted, and unweighted sound pressure levels will be presented. This approach will be contrasted with the ANSI S12-42 standard for measuring impulse peak insertion loss for hearing protection devices.

Noise overstimulation of young adult UMHET4 mice accelerates age-related hearing loss

Many factors contribute to hearing loss commonly found in older adults. There can be natural aging of cellular elements, hearing loss previously induced by environmental factors such as noise or ototoxic drugs as well as genetic and epigenetic influences. Even when noise overstimulation does not immediately cause permanent hearing loss it has recently been shown to increase later age-related hearing loss (ARHL). The present study further investigated this condition in the UMHET4 mouse model by comparing a small arms fire (SAF)-like impulse noise exposure that has the greatest immediate effect in more apical cochlear regions to a broadband noise (BBN) exposure that has the greatest immediate effect in more basal cochlear regions. Both noise exposures were given at levels that only induced temporary auditory brainstem response (ABR) threshold shifts (TS). Mice were noise exposed at 5 months of age followed by ABR assessment at 6, 12, 18, 21, and 24 months of age. Mice that received the SAF-like impulse noise had accelerated age-related TS at 4 kHz that appeared at 12 months of age (significantly increased compared to no-noise controls). This increased TS at 4 kHz continued at 18 and 21 months but was no longer significantly greater at 24 months of age. The SAF-like impulse noise also induced a significantly greater mean TS at 48 kHz, first appearing at 18 months of age and continuing to be significantly greater than controls at 21 and 24 months. The BBN induced a different pace and pattern of enhanced age-related ABR TS. The mean TS for the BBN group first became significantly greater than controls at 18 months of age and only at 48 kHz. It remained significantly greater than controls at 21 months but was no longer significantly greater at 24 months of age. Results, therefore, show different influences on ARHL for the two different noise exposure conditions. Noise-induced enhancement appears to provide more an acceleration than overall total increase in ARHL.

Hydrogen Gas Inhalation Attenuates Acute Impulse Noise Trauma: A Preclinical In Vivo Study.

Molecular hydrogen (H2) has shown therapeutic potential in several oxidative stress-related conditions in humans, is well-tolerated, and is easily administered via inhalation.The aim of this preclinical in vivo study was to investigate whether impulse noise trauma can be prevented by H2 when inhaled immediately after impulse noise exposure. Guinea pigs (n = 26) were subjected to impulse noise (n = 400; 156 dB SPL; 0.33/s; n = 11; the Noise group), to impulse noise immediately followed by H2 inhalation (2 mol%; 500 ml/min; 1 hour; n = 10; the Noise + H2 group), or to H2 inhalation (n = 5; the H2 group). The acoustically evoked ABR threshold at 3.15, 6.30, 12.5, 20.0, and 30.0 kHz was assessed before and 4 days after impulse noise and/or H2 exposure. The cochleae were harvested after the final ABR assessment for quantification of hair cells. Noise exposure caused ABR threshold elevations at all frequencies (median 35, 35, 30, 35, and 35 dB SPL, the Noise group; 20, 25, 10, 13, and 20 dB SPL, the Noise + H2 group; P < .05) but significantly less so in the Noise + H2 group (P < .05). Outer hair cell (OHC) loss was in the apical, mid, and basal regions 8.8%, 53%, and 14% in the Noise group and 3.5%, 22%, and 1.2% in the Noise + H2 group. The corresponding inner hair cell (IHC) loss was 0.1%, 14%, and 3.5% in the Noise group and 0%, 2.8%, and 0% in the Noise + H2 group. The difference between the groups was significant in the basal region for OHCs (P = .003) and apical (P = .033) and basal (P = .048) regions for IHCs. Acute acoustic trauma can be reduced by H2 when inhaled immediately after impulse noise exposure.

Morphology changes in the cochlea of impulse noise-induced hidden hearing loss

Background This study was focused on impulse noise induces hidden hearing loss. Objectives This study was designed to determine the morphology changes of noise-induced hidden hearing loss (NIHHL). Method Fifteen guinea pigs were divided into three groups: noise-induced hidden hearing loss (NIHHL) group, noise-induced hearing loss (NIHL) group, and normal control group. For the NIHHL group, guinea pigs were exposed to 15 times of impulse noise with peak intensity of 163 dB SPL at one time. For the NIHL group, animals were exposed to two rounds of 100 times impulse noise, and the time interval is 24 h. Auditory brain response (ABR) was tested before, immediately, 24 h, one week, and one month after noise exposure to evaluate cochlear physiology changes. One month after noise exposure, all guinea pigs in three groups were sacrificed, and basement membranes were carefully dissected immediately after ABR tests. The cochlea samples were observed by transmission electron microscopy (TEM) to find out the morphology changes. Result The ABR results showed that 15 times of impulse noise exposure could cause NIHHL in guinea pigs and 200 times could cause completely hearing loss. Impulse noise exposure could cause a dramatic increase of mitochondria in the inner hair cell. The structures of ribbon synapse and heminode were also obviously impaired compared to the normal group. The nerve fiber and myelin sheath remained intact after impulse noise exposure. Conclusion This research revealed that impulse noise could cause hidden hearing loss, and the changes in inner hair cells, ribbon synapse, and heminode all played a vital role in the pathogenesis of hidden hearing loss.

Managing occupational noise from blasts

The aim of this work is to examine the current best practice for the assessment of auditory hazards associated with occupational impulsive noise for a UK-based test site. A summary of the literature is presented on the measurement methodologies, hearing conservation, and relevant guidance for the selection of hearing protection within the context of near-field impulsive noise. The current U,K. best practice recommends the adapted HML method from Defence Standard 0027:2015 using a C-peak measurement of exposure to compare with the national regulations. On-site measurements were made at the DNV Spadeadam Testing and Research Site (STaR), which performs full-scale high-intensity blast testing. Analyses of the trials data show that the C-peak personnel exposures resulted in acceptable levels below the 140dBCpk limit within the national regulations when using the prescribed hearing protection, according to the adapted HML method. It is concluded that the adapted HML assessment is unclear on how excessive low-frequency content and multiple pressure peaks are accounted for. The implication of this work is that further research is required to improve current best practice to quantify the uncertainties introduced by the additional characteristics found within real impulsive noise exposures.

Suprathreshold Auditory Measures for Detecting Early-Stage Noise-Induced Hearing Loss in Young Adults.

Over 1 billion young adults are at risk for developing noise-induced hearing loss (NIHL) due to their habit of listening to music at loud levels. The gold standard for detecting NIHL is the audiometric notch around 3,000 to 6,000 Hz observed in pure tone audiogram. However, recent studies suggested that suprathreshold auditory measures might be more sensitive to detect early-stage NIHL in young adults. The present study compared suprathreshold measures in individuals with high and low noise exposure backgrounds (NEBs). We hypothesized that individuals with high NEB would exhibit reduced performance on suprathreshold measures than those with low NEB. An initial sample of 100 English-speaking healthy adults (18-35 years; females = 70) was obtained from five university classes. We identified 15 participants with the lowest NEB scores (10 females) and 15 participants with the highest NEB scores (10 females). We selected a sample of healthy young adults with no history of middle ear infection, and those in the low NEB group were selected with no history of impulse noise exposure. The study included conventional audiometry, extended high-frequency audiometry, middle ear muscle reflex (MEMR) thresholds, distortion-product otoacoustic emissions (DPOAEs), QuickSIN, and suprathreshold auditory brainstem response (ABR) measures. We used independent sample t-tests, correlation coefficients, and linear mixed model analysis to compare the audiometric measures between the NEB groups. The prevalence of audiometric notch was low in the study sample, even for individuals with high NEB. We found that: (1) individuals with high NEB revealed significantly reduced QuickSIN performance than those with low NEB; (2) music exposure via earphone revealed a significant association with QuickSIN; (3) individuals with high NEB revealed significantly reduced DPOAEs and ABR wave I amplitude compared with individuals with low NEB; (4) MEMR and ABR latency measures showed a modest association with NEB; and (5) audiometric thresholds across the frequency range did not show statistically significant association with NEB. Our results suggest that young adults with high NEB might exhibit impaired peripheral neural coding deficits leading to reduced speech-in-noise (SIN) performance despite clinically normal hearing thresholds. SIN measures might be more sensitive than audiometric notch for detecting early-stage NIHL in young adults.

D-methionine administered as late as 36 hours post-noise exposure rescues from permanent threshold shift and dose-dependently increases serum antioxidant levels

Objective To elucidate D-methionine’s (D-met) dose and time rescue parameters from steady-state or impulse noise-induced permanent threshold shift (PTS) and determine D-met rescue’s influence on serum and cochlear antioxidant levels. Design Five D-met doses at 0, 50, 100, or 200 mg/kg/dose administered starting at 1, 24, or 36 hours post steady-state or impulse noise exposure. Auditory brainstem responses at baseline and 21 days post-noise measured PTS. Serum (superoxide dismutase [SOD], catalase [CAT],, glutathione reductaseand glutathione peroxidase [GPx]) and cochlear (Glutathione [GSH] and glutathione disulphide [GSSG]) antioxidant levels measured physiological impact. Study Sample Chinchillas (10/study group; 6–8/confirmatory groups). Results D-met significantly reduced PTS for impulse noise (100 mg [2, 6, 14 and 20 kHz]; 200 mg [2, 14 and 20 kHz]) and steady-state noise (all dosing groups, time parameters and tested frequencies). PTS reduction did not significantly vary by rescue time. D-met significantly increased serum SOD (100 and 200 mg for 24 hour rescue) and GPx (50 mg/kg at 24 hour rescue) at 21 days post-noise. Cochlear GSH and GSSG levels were unaffected relative to control. Conclusion D-met rescues from steady-state and impulse noise-induced PTS even when administered up to 36 hours post-noise and dose-dependently influences serum antioxidant levels even 21 days post-noise. D-met’s broad and effective dose/time window renders it a promising antioxidant rescue agent.

Preloaded D-methionine protects from steady state and impulse noise-induced hearing loss and induces long-term cochlear and endogenous antioxidant effects.

ObjectiveDetermine effective preloading timepoints for D-methionine (D-met) otoprotection from steady state or impulse noise and impact on cochlear and serum antioxidant measures.DesignD-met started 2.0-, 2.5-, 3.0-, or 3.5- days before steady-state or impulse noise exposure with saline controls. Auditory brainstem response (ABRs) measured from 2 to 20 kHz at baseline and 21 days post-noise. Samples were then collected for serum (SOD, CAT, GR, GPx) and cochlear (GSH, GSSG) antioxidant levels.Study sampleTen Chinchillas per group.ResultsPreloading D-met significantly reduced ABR threshold shifts for both impulse and steady state noise exposures but with different optimal starting time points and with differences in antioxidant measures.For impulse noise exposure, the 2.0, 2.5, and 3.0 day preloading start provide significant threshold shift protection at all frequencies. Compared to the saline controls, serum GR for the 3.0 and 3.5 day preloading groups was significantly increased at 21 days with no significant increase in SOD, CAT or GPx for any impulse preloading time point. Cochlear GSH, GSSG, and GSH/GSSG ratio were not significantly different from saline controls at 21 days post noise exposure.For steady state noise exposure, significant threshold shift protection occurred at all frequencies for the 3.5, 3.0 and 2.5 day preloading start times but protection only occurred at 3 of the 6 test frequencies for the 2.0 day preloading start point. Compared to the saline controls, preloaded D-met steady-state noise groups demonstrated significantly higher serum SOD for the 2.5–3.5 day starting time points and GPx for the 2.5 day starting time but no significant increase in GR or CAT for any preloading time point. Compared to saline controls, D-met significantly increased cochlear GSH concentrations in the 2 and 2.5 day steady-state noise exposed groups but no significant differences in GSSG or the GSH/GSSG ratio were noted for any steady state noise-exposed group.ConclusionsThe optimal D-met preloading starting time window is earlier for steady state (3.5–2.5 days) than impulse noise (3.0–2.0). At 21 days post impulse noise, D-met increased serum GR for 2 preloading time points but not SOD, CAT, or GpX and not cochlear GSH, GSSG or the GSH/GSSG ratio. At 21 days post steady state noise D-met increased serum SOD and GPx at select preloading time points but not CAT or GR. However D-met did increase the cochlear GSH at select preloading time points but not GSSG or the GSH/GSSG ratio.

Pure Tone Audiometry Evaluation Method Effectiveness in Detecting Hearing Changes Due to Workplace Ototoxicant, Continuous Noise, and Impulse Noise Exposures.

The purpose of this retrospective cohort study was to compare the relative risks (RR) of hearing impairment due to co-exposure of continuous noise, impulse noise, metal ototoxicants, and organic solvent ototoxicants using several pure tone audiometry (PTA) evaluation methods. Noise and ototoxicant exposure and PTA records were extracted from a DoD longitudinal repository and were analyzed for U.S. Air Force personnel (n = 2372) at a depot-level aircraft maintenance activity at Tinker Air Force Base, Oklahoma using an historical cohort study design. Eight similar exposure groups based on combinations of ototoxicant and noise exposure were created: (1) Continuous noise (reference group); (2) Continuous noise + Impulse noise; (3) Metal exposure + Continuous noise; (4) Metal exposure + Continuous noise + Impulse noise; (5) Solvent exposure + Continuous noise; (6) Solvent exposure + Continuous noise + Impulse noise; (7) Metal exposure + Solvent exposure + Continuous noise; and (8) Metal exposure + Solvent exposure + Continuous noise + Impulse noise. RR of hearing impairment compared to the Continuous noise-exposed reference group was assessed with five PTA evaluation methods including (1) U.S. Department of Defense (DoD) Significant Threshold Shift (STS), (2) Occupational Safety and Health Administration (OSHA) age-adjusted STS, (3) National Institute for Occupational Safety and Health (NIOSH) STS, (4) NIOSH Material Hearing Impairment, and (5) All Frequency Threshold Average. Hearing impairment was significantly worse for SEG (2) combined exposure to continuous noise and impulse noise only for the PTA evaluation method (2) OSHA Age Adjusted with an RR of 3.11, [95% confidence interval (CI), 1.16-8.31] and was nearly significantly different using PTA evaluation method (4) NIOSH Material Hearing Impairment with an RR of 3.16 (95% CI, 0.99-10.15). Despite no significant differences for SEGs with an ototoxicant exposure, PTA evaluation method (3) NIOSH STS was most sensitive in detecting hearing changes for SEG (8) Metal exposure + Solvent exposure + Continuous noise + Impulse noise as demonstrated by a RR of 1.12 (95% CI, 0.99-1.27). Results suggest that a single PTA evaluation technique may not be adequate in fully revealing hearing impairment risk due to all stressors and tailoring the PTA evaluation technique to the hazards present in the workplace could better detect hearing impairment. Additionally, results suggest that PTA may not be effective as the sole technique for evaluating hearing impairment due to ototoxicant exposure with continuous noise co-exposure.

Impulse Noise Induced Hidden Hearing Loss, Hair Cell Ciliary Changes and Oxidative Stress in Mice.

Recent studies demonstrated that reversible continuous noise exposure may induce a temporary threshold shift (TTS) with a permanent degeneration of auditory nerve fibers, although hair cells remain intact. To probe the impact of TTS-inducing impulse noise exposure on hearing, CBA/J Mice were exposed to noise impulses with peak pressures of 145 dB SPL. We found that 30 min after exposure, the noise caused a mean elevation of ABR thresholds of ~30 dB and a reduction in DPOAE amplitude. Four weeks later, ABR thresholds and DPOAE amplitude were back to normal in the higher frequency region (8–32 kHz). At lower frequencies, a small degree of PTS remained. Morphological evaluations revealed a disturbance of the stereociliary bundle of outer hair cells, mainly located in the apical regions. On the other hand, the reduced suprathreshold ABR amplitudes remained until 4 weeks later. A loss of synapse numbers was observed 24 h after exposure, with full recovery two weeks later. Transmission electron microscopy revealed morphological changes at the ribbon synapses by two weeks post exposure. In addition, increased levels of oxidative stress were observed immediately after exposure, and maintained for a further 2 weeks. These results clarify the pathology underlying impulse noise-induced sensory dysfunction, and suggest possible links between impulse-noise injury, cochlear cell morphology, metabolic changes, and hidden hearing loss.

Understanding Self-reported Hearing Disability in Adults With Normal Hearing.

Despite a diagnosis of normal hearing, many people experience hearing disability (HD) in their everyday lives. This study assessed the ability of a number of demographic and auditory variables to explain and predict self-reported HD in people regarded as audiologically healthy via audiometric thresholds. One-hundred eleven adults (ages 19 to 74) with clinically normal hearing (i.e., audiometric thresholds ≤25 dB HL at all octave and interoctave frequencies between 0.25 and 8 kHz and bilaterally symmetric hearing) were asked to complete the 12-item version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) as a measure of self-reported HD. Patient history and a number of standard and expanded measures of hearing were assessed in a multivariate regression analysis to predict SSQ12 score. Patient history included age, sex, history of noise exposure, and tinnitus. Hearing-related measures included audiometry at standard and extended high frequencies, word recognition, otoacoustic emissions, auditory brainstem response, the Montreal Cognitive Assessment, and FM detection threshold. History of impulse noise exposure, speech-intelligibility index, and FM detection threshold accurately predicted SSQ12 and were able to account for 40% of the SSQ12 score. These three measures were also able to predict whether participants self-reported HD with a sensitivity of 89% and specificity of 86%. Although participant audiometric thresholds were within normal limits, higher thresholds, history of impulse noise exposure, and FM detection predicted self-reported HD.

Development and Initial Validation of the Lifetime Exposure to Noise and Solvents Questionnaire in U.S. Service Members and Veterans.

Purpose A need exists to investigate the short- and long-term impact of noise exposures during and following military service on auditory health. Currently available questionnaires are limited in their ability to meet this need because of (a) inability to evaluate noise exposures beyond a limited time frame, (b) lack of consensus on scoring, (c) inability to assess impulse exposures (e.g., firearm use), (d) lack of a single questionnaire that assesses both military and nonmilitary exposures, and (e) lack of validity and reliability data. To address these limitations, the Lifetime Exposure to Noise and Solvents Questionnaire (LENS-Q) was developed. The purpose of this report is to describe the development and initial validation of the LENS-Q as a measure of self-reported noise exposure. Method Six hundred ninety participants, consisting of current Service members and recently military-separated (within about 2.5 years) Veterans, completed the LENS-Q, additional study questionnaires, and comprehensive audiometric testing. Noise exposure scores were computed from LENS-Q responses using a simple scoring algorithm that distinguishes between different cumulative levels of exposure and allows for the inclusion of both continuous and impulse noise exposures. Results The LENS-Q demonstrates good construct validity as evidenced by measures of hearing loss, tinnitus, and subjective hearing difficulties all increasing with an increase in noise exposure scores. A logistic regression, adjusting for age and sex, revealed that participants in the highest exposure group were 2.4-3.9 times more likely to experience hearing loss, 2.7-2.8 times more likely to experience tinnitus, and 3.0-3.7 times more likely to report hearing difficulties compared with individuals in the lowest exposure group. Conclusions The LENS-Q captures noise exposure over an individual's lifetime and provides an alternative scoring metric capable of representing exposure to both continuous and impulse noise. Findings suggest that the LENS-Q is a valuable tool for capturing and measuring both military and nonmilitary noise exposure. Supplemental Material https://doi.org/10.23641/asha.14582937.